Instrument Assisted Soft Tissue Mobilization

Expert Commentary by Bernadette Petalber, DPT, COMT

The last 20 years have seen an explosion in the use of metal or hard plastic instruments to assess and treat soft-tissue injuries. This newer technique is referred to as Instrument Assisted Soft Tissue Mobilization or IASTM. “It filled a void in the therapist’s toolbox for injuries that produced adhesions and scar tissue in the fascia, muscles, tendons or ligaments. There isn’t anything else that is noninvasive that does the same thing. It can be very effective,” Dr. Bernadette Petalber told SpineUniverse.

The number of physical therapists, occupational therapists, chiropractors, athletic trainers and hand therapists who are incorporating IASTM into their treatment protocols is estimated to exceed 40,000. There are a variety of IASTM systems and tools available to practitioners, although Graston and Astym are the most prominent.IASTM is used for acute and chronic injuries as well as post-surgically.History
IASTM evolved from the ancient practice of Gua Sha in Traditional Chinese Medicine. Smooth edged instruments were used to press into the soft tissue with a scraping motion. “In the late 1980’s Graston developed a set of wood tools for use on his knee, which was not responding to traditional physical therapy. The Graston Technique was further developed at Ball State University and became a patented form of IASTM using metal instruments,” she said.

How It Works
IASTM is used for acute and chronic injuries as well as post-surgically. “IASTM works best for tendinopathies. I have had great results with rotator cuff injuries, plantar fasciitis, epicondylitis, Achilles tendinopathy, De Quervain’s tenosynovitis, and Iliotibial (IT) band syndrome,” Dr. Petalber explained. IASTM is also effective in breaking up scar tissue in post-surgical patients. “A recent knee arthroplasty responded nicely to IASTM. We saw improved scar mobility, decreased pain and increased ranges of motion,” she continued.

Injuries frequently heal with a haphazard pattern of fibers that form scars or adhesions and limit ranges of motion and produce pain. The instrument glides over the area of pain, and the therapist will feel bumps, which help to locate the problem area. “IASTM breaks up the scar tissue and creates an acute healing response which stimulates the production of fibroblasts. Research confirms fibroblasts synthesize collagen and elastin in the extracellular matrix strengthening the injured area,” Dr. Petalber explained.

Contraindications
Some patients may not be able to have IASTM. “Those patients who have significant bruises from very recent trauma, skin infections, open wounds, unhealed fractures, varicose veins or burn scars should not have the therapy. Also, osteomyelitis, myositis ossificans, significant kidney dysfunction and anticoagulant use are a contraindication,” she said.

The treatment can be uncomfortable, and the depth that is used can vary between therapists, but intolerance is rare. Patients can expect a reddening of the skin and increased warmth after the treatment. Occasionally mild bruising can occur.

Evaluation and Treatment Protocol
Dr. Petalber has been impressed with the ability of the tools to locate problem areas on patients. Initially, patients are examined to determine if they have scar tissue that may be contributing to their problem. Some patients may only have pain in a portion of a range of motion or lifting an object in a certain way. The therapist will have the patient perform the movement that brings on the pain and uses the tools to locate the problem. “The tools are very helpful in locating the cause of the problem,” she said.

“Ideally, we treat patients twice a week for 5-10 minutes. The length of therapy varies with the extent of the injury, but most patients complete treatment within 4-6 weeks,” Dr. Petalber explained. Heat is frequently used before the treatment to increase tissue pliability. She uses IASTM in conjunction with exercise therapy, including, stretching, strengthening, and range of motion exercises.

Benefits and Recommendations
Dr. Petalber is especially happy with the results she sees in chronic cases that have not responded to standard physical therapy. “Chronic repetitive motion injuries frequently have scar tissue, and if the patient has not had some form of IASTM, the injury becomes chronic and won’t heal properly. The benefits we see clinically are a restoration of pain-free movement and function in patients,” she explained.

Chronic neck, back and hip pain from accidents and injuries also respond well to IASTM. Patients who have had chiropractic, and standard physical therapy, including electric stimulation, ultrasound, massage therapy and exercise therapy may still have chronic pain. Dr. Petalber recommends having a certified IASTM practitioner perform the evaluation. “It’s quick and easy to do; the tools are diagnostic. A simple exam will be able to locate the lesions if they are there,” she concluded.